Primary and secondary resistance of H. pylori to levofloxacin is approximately 10% of the tested strains. The susceptibility test does not influence therapeutic outcome of triple therapy with amoxicillin and levofloxacin in patients never treated, while it is determinant for patients who were previously treated without success.
Optimal therapy for Helicobacter pylori infection consists of a proton pump inhibitor in combination with metronidazole (or tinidazole) and clarithromycin. This therapy presents eradication rates of H. pylori from 70% up to 90% and few side-effects. 1, 2 However, antibiotic resistance jeopardizes the success of this regimen. 3, 4 A large number of studies have demonstrated the prevalence of H. pylori resistance to metronidazole and clarithromycin in various countries. In a recent European survey, resistance ranged from 10% to 50% for metronidazole and 0% to 15% for clarithromycin, whilst resistance to amoxicillin has also been reported but appears to be uncommon. 5,6 Several studies have evaluated the relationship between pre-treatment antibiotic resistance and eradication rate using different standard treatments and performing a susceptibility test before the initiation of the therapeutic regimen. These studies used standard treatments without taking into consideration the results of the susceptibility test; the impact of antibiotic resistance on eradication rate was calculated retrospectively. 7±10 To date there are no prospective studies that use culture and antibiotic susceptibility tests to choose a speci®c therapy for H. pylori eradication. The aim of this study has therefore been to examine whether a preliminary in vitro susceptibility test of SUMMARY Background: Helicobacter pylori treatment failure may be due to resistance to macrolides and 5-nitroimidazoles. Aim: To test whether a preliminary in vitro susceptibility test of H. pylori to tinidazole and clarithromycin and a consequent speci®c regimen could improve the eradication rate. Methods: A total of 109 consecutive H. pylori-positive patients with dyspeptic symptoms were included. At endoscopy, biopsy from the antrum was obtained for H. pylori culture and antimicrobial susceptibility testing. Fifty-six patients were treated with omeprazole, tinidazole and clarithromycin for 10 days (group OTC) and 53 patients received therapy on the basis of the suscepti-
Ineffective oesophageal motility (IOM) is a functional disorder affecting about 50% of gastro-oesophageal reflux disease (GORD) patients. This disease in a severe form limits the clearing ability of the oesophagus and is considered one of the predictive factors for poorer GORD resolution. Capsaicin, the active compound of red pepper, exerts a prokinetic effect on oesophageal motility in healthy subjects by increasing the amplitude of body waves, even if no evidence exists on its possible role in situations of reduced motility. The aim of the study was to evaluate the effect of an acute administration of capsaicin on the oesophageal motor pattern in a group of GORD patients affected by severe IOM. Twelve GORD patients with severe IOM received an intra-oesophageal administration of 2 mL of a red pepper-olive oil mixture and 2 mL of olive oil alone serving as a control during a stationary manometry. The motor patterns of the oesophageal body and lower oesophageal sphincter (LOS) were analysed at baseline and after the infusion of the two stimuli. The administration of capsaicin induced a significant improvement in oesophageal body contractility when compared with baseline. The velocity of propagation of waves and the LOS basal tone remained unchanged. The motor pattern was unaltered by the administration of olive oil alone. An acute administration of capsaicin seems to improve the motor performance of the oesophageal body in patients with ineffective motility. Whether this could represent the basis for further therapeutic approaches of GORD patients needs further study.
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